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Pharm test 3 lilk8to

Ch. 21, 23, 24 lilk8tob-Cardiac drugs

Drugs that increase myocardial contractility inotropic
drugs that increase the rate at which the heart beats chronotropic
drugs that accelerate conduction- electrical dromotropic
Most commonly prescribed Cardiac Glycoside: Digoxin
Cardiac glycosides help clients w/ heart failure by causing: an increase in myocardial contractility (+inotropic)
Cardiac glycosides- MOA Increase SV, Reduce heart size during diastole, decrease BP, increase coronary circulation
Tropic effects of Digoxin +inotropic, -chronotropic(reduces HR), -dromotropic(prolongs referactory periods)
Digoxin (Lanoxin) drug class: cardiac glycosides
Digoxin used for: heart failure and atrial fibbrilation and flutter
Normal therapeutic level of Digoxin: 0.5 to 2 ng/ml
Digoxin increases the force of contraction, thus: increases the ejection fraction- as more blood is ejected w/ each contraction, there is less blood remaining in the ventricle (less pressure built up)
Cardiac glycosides SE: dysrhythmias (brady or tachy), HA, confusion, colored vision, halo vision, flickering lights
Digoxin *classic* side effects: bradycardia, N/V, colored vision, halo vision
What will increase digoxin's toxicity? low potassium levels
Digoxin drug interactions: K+ wasting diuretics (low K+=toxic), antiepileptics (decrease absorption)
What do you check before administering Digoxin? serum K+ levels, and creatinine, Ca, Mg, Na
Large amts of ___ decrease digoxin absorption bran
Need to do this before administer digoxin (not a serum level) Take pulse- must 60-120 bpm
Antidote to digoxin Digibind
Digoxin: increase or decrease urine: increase
Digoxin- edema increased or decreased? decreased
Digoxin- SOB, dyspnea & rales increased or decreased? these are all decreased
Can you eat ice cream or antacids while on digoxin? yes, but take dose 2 hrs before or after these products
What are the 3 antianginal classes? nitrates, beta-blockers, calcium channel blockers
How do nitrates work as antianginals? dilate constricted coronary arteries- increases O2 & nutrient supply to heart muscle
Nitroglycerin (Nitrostat) drug class: nitrate- antianginal
Isosorbide (Imdur) drug class: nitrate- antianginal
Procardia drug class: nitrate- antianginal
nitrates used for: coronary artery spasms, narrowed arteries from atherosclerosis
most common side effect from nitrates for anginal pain: headache most common, also tachycardia, postural hypotension
Which antianginal agent has a tolerance develop? nitrates if taken around the clock
How do beta-blockers work for anginal pain? slow the HR (-chrono), decrease myocardial contractility (-ino)
Beta blockers chronotropic and inotropic effect are both: negative
Beta blockers used for: angina & MI, hypertension
Atenolol drug class: Beta blocker (antianginal)
Metaprolol (Lopressor) drug class beta blocker (antianginal)
Calcium channel blockers work by: potent peripheral vasodilating properties
CCBs decrease O2 demand by causing peripheral artery vasodilation and by a neg. inotropic action (-contractility)
CCBs effect on BP: reduced from dilated peripheral vessels
CCBs used for: angina, hypertension, supraventricular tachycardia, migraines, Raynaud's disease
CCBs Side effects: hypotension, palpitations, heart failure, peripheral edema, constipation, flushing, wheezing
Diltiazem drug class: calcium channel blockers d - antianginal
Nifedipine drug class: calcium channel blockers n - antianginal
Verapamil drug class: calcium channel blockers antianginal
These work by decreasing venous return to the heart (preload) and decreasing systemic vascular resistance (afterload) nitrates for anginal pain
These work by decreasing the calcim influx into the sm. muscle- vascular relaxation calcium channel blockers for anginal pain
These work by slowing the HR and decreasing contractility, thereby decreasing oxygen demands beta-blockers for anginal pain
Take sublingual nitroglycerine in what position (sitting, standing, laying down)? Supine @ 1st sign of angina to prevent fainting
How do you store nitroglycerine? In the dark in a non-warm place
What antianginal drug will always give you a headache? nitrates
How do you take nitrates for anginal pain? 1 sublingual every 5 minutes (up to 3)
Nitrate bottle can be open for how long? 3 months- know it is too old if no longer burns
Which antianginal class will cause constipation? Beta blockers
Which antianginal class can exacerbate respiratory conditions? Beta blockers
Centrally acting alpha2 adrenergic agents are used for: hypertension
SNS stimulation causes: Increased HR & force of contraction, constriction of blood vessels, release of renin from kidney = hypertension
the alpha2 adrenergic agents reduce: sympathetic outflow from the CNS, reducing BP
Clonidine (Catapres) drug class: centrally acting alpha 2 adrenergic (antihypertensive)
Clonidine (Catapres) uses: hypertension, managing opioid withdrawal, migraines
Clonidine (alpha2) side effects hypotension, dry mouth, drowsy, constipation, HA, rebound hypertension
ACE inhibitors work by inhibiting: the angiotensin converting enzyme (ang I ->II blocked)
What does angiotensin II do? A potent vasoconstrictor & stimulator of aldosterone secretion - stimulates Na+ and H2O resorption, which can raise BP
ACE inhibitors are used for these conditions: hypertension, used as adjunctive agents in treatment of heart failure, can stop left ventricular hypertrophy (seen post-MI)
ACE inhibitors are good for diabetic pts because: have nephroprotective effect on kidney
Main side effect of ACE inhibitors Nonproductive cough
When on ACE inhibitors, monitor what levels? Serum Potassium levels
ACE inhibitors side effects cough, loss of taste, proteinuria, hyperkalemia
ACE inhibitors- interactions: NSAIDS reduce effects; K+sparing diuretics may cause hyperkalemia
Captopril (Capoten) drug class: ACE inhibitors
What does Captopril (Capoten) do? prevents left ventricular dilation (ventricular remodeling) after an MI
Calcium Channel blockers cause: smooth muscle relaxation by blocking the binding of calcium to its receptors (prevents contraction)
deltiazem drug class calcium channel blockers
nifedipine drug class: calcium channel blockers
verapamil drug class: calcium channel blockers
Vasodilators work: directly on arteriolar smooth muscle to cause relaxation
Vasodilators do NOT work through : adrenergic receptors
Vasodilator uses: hypertension, restore hair growth
Vasodilator side effects: dizziness, HA, anxiety, edema, nasal congestion, tachycardia, dyspnea, N/V
hydralazine hydrochloride (Apresoline) drug class: vasodilators
when is hydralazine hydrochloride (apresoline) used? essential hypertension (no known cause), injectable for hypertensive emergencies
What antihypertensive should not be 1st line, and why? ACE-inhibitors, because of their serious side effects (may cause acute renal failure, hyperkalemia, proteinuria)
Use ACE-inhibitors cautiously if have: hyperkalemia, HF, reduced renal function
When should you take alpha blockers (time of day) bedtime- sleep through hypotensive effects
These can cause exacerbation of respiratory diseases- asthma, bronchospasm COPD: nonselective beta-blockers
how do nonselective beta blockers exacerbate respiratory diseases? their negative inotropic (lower contractility) effect
Angiotensin II receptor blockers work by: blocking vasoconstriction and the secretion of aldosterone
Difference between ARB's and ACE inhibitors ACE has cough, ARB doesn't
losartan (Cozaar) drug class: Angiotensin II receptor blockers (ARB's)
How long for alpha blockers to work? 4-6 weeks
On ACE inhibitors, should NOT take what supplement? potassium
With ARB's, report what: any unusual SOB, dyspnea, weight gain, chest pain, palpitations
Something pts on vasodilators should do daily: weigh self
What do loop diuretics block? chloride & sodium resorption
Loop diuretics cause dilation of: the blood vessels of the kidneys, lungs, and the rest of the body
Loop diuretics- slow or fast onset? rapid onset of action
Side effects of Loop Diuretics hypokalemia, photosensitivity, aplastic anemia
Don't take _____ with loop diuretics NSAIDS (they have the opp. effect on prostaglandin activity)
Furosemide (Lasix) drug class loop diuretics
Furosemide (Lasix)- loop diuretic used for: managing pulmonary edema & edema from HF, liver disease, nephrotic syndrome & ascites, hypertension from HF
Potassium sparing diuretics cause: sodium and water to be excreted and potassium to be retained
Spironolactone (Aldactone) drug class: K+ sparing diuretic
How does spironolactone (Aldactone) work? competitively binds to aldosterone receptors & therefore blocks the resorption of Na and H2O
Spironolactone (Aldactone) used for: hyperaldosteronism, hypertension, reversing K+ loss from Kaliuretic diuretics
K+ sparing diuretics - SE: gynecomastia, amenorrhea, post-menopausal bleeding
Drug interactions- K+ sparing diuretics No ACE-inhibitors or K+ supplements (can cause hyperkalemia), no lithium (lithium toxicity), NSAIDS decrease blood flow to kidneys
Monitor what when no Spironolactone (Aldactone) K+ levels
Thiazides: uses adjunct agents in the management of HF, hepatic cirrhosis, and edema
Thiazides work by inhibiting: sodium, potassium & chloride resorption
Thiazides - side effects dizziness, HA, blurred vision, pancreatitis, photosensitivity, hypokalemia, hyperglycemia, hyperuricemia
Thiazides - drug interactions +digoxin-> digoxin toxicity; hypokalemia ; hypoglycemics-> antagonistic (reduced effect)
hydrochlorothiazidine (HydroDIURIL) drug class: Thiazide diuretic
Diabetics taking ____ or _____ diuretics should closely monitor their blood sugar levels because these drugs can raise them. thiazide and/or loop diuretics
Signs and symptoms of hypokalemia: muscle weakness, constipation, irregular HR, lethargy
least expensive & most commonly used diuretics: Thiazide diuretics (hydroDIURIL)
Created by: lilk8tob